1821242330 NPI number — KATHLEEN MARY ROSE THURMAN FNP

Table of content: KATHLEEN MARY ROSE THURMAN FNP (NPI 1821242330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821242330 NPI number — KATHLEEN MARY ROSE THURMAN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THURMAN
Provider First Name:
KATHLEEN
Provider Middle Name:
MARY ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAYER
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821242330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-3158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLALLA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97038-8134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-529-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  200850128NP FNP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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